Patterns and research progress on the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CHANG Shimin ¹ , WANG Zhenhai ² , TIAN Kewei ³

1. Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China;
2. Department of Traumatic Orthopedic Surgery, Yantaishan Hospital, Yantai Shandong, 264001, P.R.China;
3. No.1 Department of Hip Injury and Disease, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P.R.China;

Corresponding?author：

CHANG Shimin, Email: shiminchang11@aliyun.com

Keywords：

Femoral neck fracture; trochanteric fracture; segmental femoral neck fracture; intertrochanteric line; concomitant ipsilateral fractures; intracapsular fracture; extracapsular fracture

DOI：

10.7507/1002-1892.202102090

Video：

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Objective To summarize the patterns and research progress of the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter, and to provide a common language among orthopedic surgeons for scientific exchange.Methods According to related literature and authors own experiences concerning the anatomic border between femoral neck and trochanter region, the intertrochanteric line (or intertrochanteric belt) and its capsularligament attachment footprint, fracture patterns, and treatment strategies were reviewed and analyzed.Results With the rapid growing of geriatric hip fractures, an increased incidence was noted in recent years regarding the proximal femoral comminuted fractures that involving ipsilateral intracapsular neck and extracapsular trochanter regions simultaneously. But the concept of femoral neck combined with trochanter fractures was ambiguous. Based on the anatomic type of femoral neck fracture, the location of fracture center, and the ability to achieve direct inferior calcar or anteromedial cortex-to-cortex apposition and buttress, we classified these complex fractures into 3 sub-types: ① Segmental femoral neck fractures (two separate fracture centers at subcapital and trochanteric region respectively); ② Femoral neck fracture (trans-cervical) with extension to the supero-lateral trochanteric region (fracture center in femoral neck); ③ Trochanteric fracture with extension to the medio-inferior femoral neck region (fracture center in trochanter, comminuted basicervical fracture, or variant type of comminuted trochanter fracture). For treatment strategy, surgeons should consider the unique characteristics of femoral neck and trochanter, usually with combined fixation techniques, or arthroplasty supplemented with fixation.Conclusion Currently there is no consensus on diagnosis and terminology regarding the concomitant ipsilateral fractures of femoral neck and trochanter. Further studies are needed.

Citation： CHANG Shimin, WANG Zhenhai, TIAN Kewei. Patterns and research progress on the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1079-1085. doi: 10.7507/1002-1892.202102090 Copy

1.	Boulton CL, Pollak AN. Special topic: Ipsilateral femoral neck and shaft fractures—does evidence give us the answer? Injury, 2015, 46(3): 478-483.
2.	Neogi DS, Ajay Kumar KV, Trikha V, et al. Ipsilateral femoral neck and trochanter fracture. Indian J Orthop, 2011, 45(1): 82-86.
3.	Khan W, Williams R, Hopwood S, et al. Combined intracapsular and extracapsular neck of femur fractures case series, literature review and management recommendations. Open Orthop J, 2017, 11: 600-608.
4.	Saleeb H, Kanvinde R, Rahman T. Literature review and case report: Current concepts for concomitant intra and extracapsular fractures of neck of femur in elderly patients. Trauma Case Rep, 2017, 8: 24-31.
5.	Videla-Cés M, Sales-Pérez JM, Girós-Torres J, et al. A retrospective cohort study of concomitant ipsilateral extra-capsular and intra-capsular fractures of the proximal femur. Are they casual findings or an undervalued reality? Injury, 2017, 48(7): 1558-1564.
6.	吳偉, 沈波, 王迪, 等. 老年同側股骨頸并粗隆間骨折的手術療效隨訪. 中國矯形外科雜志, 2011, 19(24): 2049-2051.
7.	徐勇強, 閻戈, 康亦鋒, 等. 老年同側股骨粗隆間并股骨頸骨折的手術策略. 中國骨與關節損傷雜志, 2016, 31(2): 124-126.
8.	季佳慶, 樊健. 同側股骨頸伴股骨粗隆間骨折的治療進展. 中國骨與關節損傷雜志, 2020, 35(2): 220-222.
9.	張世民. 老年髖部轉子間骨折. 北京: 科學出版社, 2019: 276-284.
10.	Russell TA. Chapter 48: Intertrochanteric Fractures of the hip//Court-Brown CM, Heckman JD, McQueen MM, et al. Rockwood and Green’s Fractures in Adults. 8th Ed. 北京: 北京大學醫學出版社, 2016: 2080.
11.	Kellam JF, Meinberg EG, Agel J, et al. Fracture and Dislocation Classification Compendium-2018: International Comprehensive Classification of Fractures and Dislocations Committee. J Orthop Trauma, 2018, 32(Suppl 1): S33-S34.
12.	張世民, 余斌. AO/OTA-2018 版股骨轉子間骨折分類的解讀與討論. 中華創傷骨科雜志, 2018, 20(7): 583-587.
13.	Tamaki Y, Goto T, Wada K, et al. Anatomic evaluation of the insertional footprints of the iliofemoral and ischiofemoral ligaments: a cadaveric study. BMC Musculoskelet Disord, 2020, 21(1): 828. doi: 10.1186/s12891-020-03848-4.
14.	Telleria JJ, Lindsey DP, Giori NJ, et al. A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction. Clin Anat, 2014, 27(3): 489-497.
15.	胡孫君, 杜守超, 熊文峰, 等. 股骨近端防旋髓內釘內固定治療高位股骨轉子間骨折. 中國修復重建外科雜志, 2021, 35(3): 307-311.
16.	Yoo JI, Cha Y, Kwak J, et al. Review on basicervical femoral neck fracture: definition, treatments, and failures. Hip Pelvis, 2020, 32(4): 170-181.
17.	Dekhne MS, Thomas HM, Haider T, et al. Treatment and outcomes of basicervical femoral neck fractures: A systematic review. J Orthop Surg (Hong Kong), 2021, 29(1): 23094990211003344. doi: 10.1177/23094990211003344.
18.	Zhang Y, Sun Y, Liao S, et al. Three-dimensional mapping of medial wall in unstable pertrochanteric fractures. Biomed Res Int, 2020, 2020: 8428407. doi: 10.1155/2020/8428407.
19.	Li M, Li ZR, Li JT, et al. Three-dimensional mapping of intertrochanteric fracture lines. Chin Med J (Engl), 2019, 132(21): 2524-2533.
20.	Li J, Tang S, Zhang H, et al. Clustering of morphological fracture lines for identifying intertrochanteric fracture classification with Hausdorff distance-based K-means approach. Injury, 2019, 50(4): 939-949.
21.	Li C, Zhao D, Xu X, et al. Three-dimensional computed tomography (CT) mapping of intertrochanteric fractures in elderly patients. Med Sci Monit, 2020, 26: e925452. doi: 10.12659/MSM.925452.
22.	Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric Femur Fracture Treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
23.	衛禛, 熊文峰, 張世民. 轉子間骨折中股骨干近側斷面環周皮質的 CT 影像學測量及其臨床意義. 中國臨床解剖學雜志, 2020, 38(6): 639-645.
24.	Pemberton DJ, Kriebich DN, Moran CG. Segmental fracture of the neck of the femur. Injury, 1989, 20(5): 306-307.
25.	An HS, Wojcieszek JM, Cooke RF, et al. Simultaneous ipsilateral intertrochanteric and subcapital fracture of the hip. A case report. Orthopedics, 1989, 12(5): 721-723.
26.	Isaacs C, Lawrence B. Concomitant ipsilateral intertrochanteric and subcapital fracture of the hip. J Orthop Trauma, 1993, 7(2): 146-148.
27.	Cohen I, Rzetelny V. Simultaneous ipsilateral pertrochanteric and subcapital fractures. Orthopedics, 1999, 22(5): 535-536.
28.	Loupasis G, Ntagiopoulos PG, Asimakopoulos A. Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report. J Med Case Rep, 2010, 4: 363. doi: 10.1186/1752-1947-4-363.
29.	Tahir M, Lakkol S, Naique S. Segmental neck of femur fractures: A unique case report of an ipsilateral subcapital, greater trochanteric and intertrochanteric fracture and proposed management algorithm. Int J Surg Case Rep, 2014, 5(5): 277-281.
30.	Taniguchi D, Fujiwara H, Kobashi H, et al. Successful treatment of concomitant ipsilateral intracapsular and extracapsular hip fractures. Orthopedics, 2013, 36(6): 837-839.
31.	Dhar SA, Mir MR, Butt MF, et al. Osteosynthesis for a T-shaped fracture of the femoral neck and trochanter: a case report. J Orthop Surg (Hong Kong), 2008, 16(2): 257-259.
32.	Yoo H, Cho Y, Hwang S. Outcomes of combined neck and trochanter fractures of the femur treated with cephallomedullary nail in elderly. Hip Pelvis, 2019, 31(4): 200-205.

1. Boulton CL, Pollak AN. Special topic: Ipsilateral femoral neck and shaft fractures—does evidence give us the answer? Injury, 2015, 46(3): 478-483.
2. Neogi DS, Ajay Kumar KV, Trikha V, et al. Ipsilateral femoral neck and trochanter fracture. Indian J Orthop, 2011, 45(1): 82-86.
3. Khan W, Williams R, Hopwood S, et al. Combined intracapsular and extracapsular neck of femur fractures case series, literature review and management recommendations. Open Orthop J, 2017, 11: 600-608.
4. Saleeb H, Kanvinde R, Rahman T. Literature review and case report: Current concepts for concomitant intra and extracapsular fractures of neck of femur in elderly patients. Trauma Case Rep, 2017, 8: 24-31.
5. Videla-Cés M, Sales-Pérez JM, Girós-Torres J, et al. A retrospective cohort study of concomitant ipsilateral extra-capsular and intra-capsular fractures of the proximal femur. Are they casual findings or an undervalued reality? Injury, 2017, 48(7): 1558-1564.
6. 吳偉, 沈波, 王迪, 等. 老年同側股骨頸并粗隆間骨折的手術療效隨訪. 中國矯形外科雜志, 2011, 19(24): 2049-2051.
7. 徐勇強, 閻戈, 康亦鋒, 等. 老年同側股骨粗隆間并股骨頸骨折的手術策略. 中國骨與關節損傷雜志, 2016, 31(2): 124-126.
8. 季佳慶, 樊健. 同側股骨頸伴股骨粗隆間骨折的治療進展. 中國骨與關節損傷雜志, 2020, 35(2): 220-222.
9. 張世民. 老年髖部轉子間骨折. 北京: 科學出版社, 2019: 276-284.
10. Russell TA. Chapter 48: Intertrochanteric Fractures of the hip//Court-Brown CM, Heckman JD, McQueen MM, et al. Rockwood and Green’s Fractures in Adults. 8th Ed. 北京: 北京大學醫學出版社, 2016: 2080.
11. Kellam JF, Meinberg EG, Agel J, et al. Fracture and Dislocation Classification Compendium-2018: International Comprehensive Classification of Fractures and Dislocations Committee. J Orthop Trauma, 2018, 32(Suppl 1): S33-S34.
12. 張世民, 余斌. AO/OTA-2018 版股骨轉子間骨折分類的解讀與討論. 中華創傷骨科雜志, 2018, 20(7): 583-587.
13. Tamaki Y, Goto T, Wada K, et al. Anatomic evaluation of the insertional footprints of the iliofemoral and ischiofemoral ligaments: a cadaveric study. BMC Musculoskelet Disord, 2020, 21(1): 828. doi: 10.1186/s12891-020-03848-4.
14. Telleria JJ, Lindsey DP, Giori NJ, et al. A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction. Clin Anat, 2014, 27(3): 489-497.
15. 胡孫君, 杜守超, 熊文峰, 等. 股骨近端防旋髓內釘內固定治療高位股骨轉子間骨折. 中國修復重建外科雜志, 2021, 35(3): 307-311.
16. Yoo JI, Cha Y, Kwak J, et al. Review on basicervical femoral neck fracture: definition, treatments, and failures. Hip Pelvis, 2020, 32(4): 170-181.
17. Dekhne MS, Thomas HM, Haider T, et al. Treatment and outcomes of basicervical femoral neck fractures: A systematic review. J Orthop Surg (Hong Kong), 2021, 29(1): 23094990211003344. doi: 10.1177/23094990211003344.
18. Zhang Y, Sun Y, Liao S, et al. Three-dimensional mapping of medial wall in unstable pertrochanteric fractures. Biomed Res Int, 2020, 2020: 8428407. doi: 10.1155/2020/8428407.
19. Li M, Li ZR, Li JT, et al. Three-dimensional mapping of intertrochanteric fracture lines. Chin Med J (Engl), 2019, 132(21): 2524-2533.
20. Li J, Tang S, Zhang H, et al. Clustering of morphological fracture lines for identifying intertrochanteric fracture classification with Hausdorff distance-based K-means approach. Injury, 2019, 50(4): 939-949.
21. Li C, Zhao D, Xu X, et al. Three-dimensional computed tomography (CT) mapping of intertrochanteric fractures in elderly patients. Med Sci Monit, 2020, 26: e925452. doi: 10.12659/MSM.925452.
22. Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric Femur Fracture Treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
23. 衛禛, 熊文峰, 張世民. 轉子間骨折中股骨干近側斷面環周皮質的 CT 影像學測量及其臨床意義. 中國臨床解剖學雜志, 2020, 38(6): 639-645.
24. Pemberton DJ, Kriebich DN, Moran CG. Segmental fracture of the neck of the femur. Injury, 1989, 20(5): 306-307.
25. An HS, Wojcieszek JM, Cooke RF, et al. Simultaneous ipsilateral intertrochanteric and subcapital fracture of the hip. A case report. Orthopedics, 1989, 12(5): 721-723.
26. Isaacs C, Lawrence B. Concomitant ipsilateral intertrochanteric and subcapital fracture of the hip. J Orthop Trauma, 1993, 7(2): 146-148.
27. Cohen I, Rzetelny V. Simultaneous ipsilateral pertrochanteric and subcapital fractures. Orthopedics, 1999, 22(5): 535-536.
28. Loupasis G, Ntagiopoulos PG, Asimakopoulos A. Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report. J Med Case Rep, 2010, 4: 363. doi: 10.1186/1752-1947-4-363.
29. Tahir M, Lakkol S, Naique S. Segmental neck of femur fractures: A unique case report of an ipsilateral subcapital, greater trochanteric and intertrochanteric fracture and proposed management algorithm. Int J Surg Case Rep, 2014, 5(5): 277-281.
30. Taniguchi D, Fujiwara H, Kobashi H, et al. Successful treatment of concomitant ipsilateral intracapsular and extracapsular hip fractures. Orthopedics, 2013, 36(6): 837-839.
31. Dhar SA, Mir MR, Butt MF, et al. Osteosynthesis for a T-shaped fracture of the femoral neck and trochanter: a case report. J Orthop Surg (Hong Kong), 2008, 16(2): 257-259.
32. Yoo H, Cho Y, Hwang S. Outcomes of combined neck and trochanter fractures of the femur treated with cephallomedullary nail in elderly. Hip Pelvis, 2019, 31(4): 200-205.

Chinese Journal of Reparative and Reconstructive Surgery

Patterns and research progress on the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter

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